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Truly unexplained falls after evaluation for syncope: A new diagnostic entity with severe prognosis
Andrea Ungar1, Alice Ceccofiglio1, Chiara Mussi2
1Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy.
European Journal of Internal Medicine
|February 17, 2022
Summary
Older adults with dementia experiencing truly unexplained falls face a higher one-year mortality risk. This finding highlights the need for comprehensive geriatric assessments to improve prognosis in this high-risk group.
Area of Science:
- Geriatrics
- Neurology
- Cardiology
Background:
- Older adults with dementia are prone to falls and syncope, posing diagnostic challenges.
- Differentiating syncope from unexplained falls is crucial for risk stratification in this population.
Purpose of the Study:
- To compare the one-year mortality risk between syncope and truly unexplained falls in older adults with dementia.
- To introduce and validate the diagnostic category of "Truly Unexplained Fall".
Main Methods:
- Evaluation of 522 patients over 65 with dementia and history of transient loss of consciousness or unexplained falls.
- Diagnosis of syncope based on European Society of Cardiology guidelines.
- Classification into "Syncopal Fall" (fall with eventual syncope diagnosis) or "Truly Unexplained Fall" (fall with syncope excluded).
Main Results:
- Follow-up data available for 501 participants; 24% experienced all-cause mortality within one year.
- Truly Unexplained Falls were associated with a significantly higher mortality risk compared to syncope and Syncopal Fall.
- Advanced age, male sex, and cognitive/functional impairment were linked to increased mortality.
Conclusions:
- The novel category "Truly Unexplained Fall" identifies a high-risk group in older adults with dementia.
- "Truly Unexplained Fall" is an independent predictor of one-year all-cause mortality.
- Comprehensive geriatric assessment is recommended for individuals with "Truly Unexplained Falls" to potentially improve outcomes.
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